Safety Profile of Dimethyl Sulfoxide–Based Liquid Embolic Agents for Neurointerventional Procedures in Neonates, Infants, and Toddlers: A Cohort Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction: DMSO (dimethyl sulfoxide) based liquid embolic agents have revolutionized the endovascular treatment of high-flow intracranial vascular malformations but can be associated with systemic and metabolic complications. Extensive safety data exists regarding the rates of such complication in adults and older children. However, relatively little published data is available on the safety profile in neonates, infants, and toddlers, which may limit uptake in the treatment of young children. We hypothesized that complication rates related to the use of these agents in young children are relatively similar to those reported in older children or adults. Methods: A single-centre retrospective cohort study was undertaken of all paediatric neuro-interventional procedures utilizing DMSO-based liquid embolic agents in patients of age < 18 years at the time of their first procedure who underwent at least one embolization procedure between 1st July 2022 and 30th June 2025. The primary outcome was the rate of complications attributable to use of DMSO-based liquid embolic agents including systemic, metabolic, neurological, and technical complications. Subgroup analyses were performed comparing results between younger (neonates, infants, and toddlers: 0 days – 36 months) and older (3 - 18 years) age subgroups. Results: A total of 66 embolization procedures were performed in 17 paediatric patients (female 6, male 11, age 2 days - 18 years, mean 4.1 years, median 2.0, SD 5.35). The most common indication for treatment was vein of Galen malformation (47 of 66 procedures, 71.2%), and 48 of 66 procedures (72.7%) were performed in the younger subgroup (0 days – 36 months). Complications attributable to use of DMSO-based liquid embolic agents occurred with 5 of 66 procedures (7.6%). Four complications occurred in the younger subgroup (4 of 48 procedures), but there was no statistically significant difference compared with the older subgroup (1 of 18 procedures) (p=0.22; Fishers exact test). These complications included one death, two transient neurological deficits, and two episodes of asymptomatic embolic migration to the lungs. Conclusion: DMSO-based liquid embolic agents had a reasonable safety profile in neonates, infants, and toddlers, that was comparable to published rates in older children and adults.
DOI: 10.3174/ajnr.a9190
Institutions: Children's Hospital at Westmead, The University of Sydney
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7128477194